I recently received a published form from the State of Florida showing that ARNPs increased 22% over the past two years. RNs only increased by 7.4% If you are a new grad wondering why you can't find a position here is your answer. Our NP mills have pumped out too many graduates for the demand of society. I don't have the data to back it up but if this is happening in Florida I would assume it is happening around the nation.
I'm licensed in Florida but moved to California years ago because I could see the tsunami of new graduates slowly starting to erode the wages of established NPs. It's now happening here in California and I have been directly affected. I can count at least another dozen of my NP colleagues around the nation who are complaining of wage deflation happening because new grads will accept a position at almost any wage. Starting wages are below those for RNs in some cases.
For those of you thinking of becoming a NP think and long and hard before you commit your money and your time. The job is enjoyable but the return on investment is declining year after the year with the flooding of the markets. Maybe one day the leaders of our nursing schools will open a book on economics and understand the relationship between supply and demand rather than stuff another useless nursing theory down our throats.
Specializes in Psychiatric and Mental Health NP (PMHNP).
We don't have an oversupply of NPs. We have a distribution problem. At least in primary care, there is a shortage of providers of all types in many parts of the country. While the number of NPs is increasing, there is still a serious shortage of primary care MDs and there is no reason to think that is going to change.
Certain MD specialties, like Ob/Gyn, are also looking at impending shortages, as the current practitioners retire and there are not enough new MDs to replace them. A lot of smaller hospitals are discontinuing L&D services. This provides opportunities for WHNPs and CNMs.
There are a lot of NP jobs out there. Small towns and cities and rural areas desperately need providers.
I am always amazed that NPs seem to think they should be able to get a job within a 5 mile radius of their current home. That is not true of any other profession. When medical students get matched, they go where they have to! Someone interested in high tech is going to move to a tech hub like Silicon Valley, Washington DC, Austin, etc. Someone who wants to be in entertainment is going to move to LA or NYC. And so on.
So, while it is difficult to get an NP job in highly desireable locations, there are plenty of other nice places to live and work.
I do agree that there need to be better standards for NP schools and would really like to see an NP residency. In addition, encourage schools to provide realistic information about where NP jobs are.
Myoglobin, I really appreciate you sharing your thoughts on this subject. I value what you've shared, and even though we don't agree on everything, I think it has been a fruitful discussion.
Do you currently practice as a psych/PMHNP? Or are you still practicing as an RN? I was just wondering what your background is.
My understanding is that the CCNE is attempting to "clamp down" on schools that aren't assisting with clinical rotations/finding preceptors. I don't think much has been done so far, but that would make a tremendous impact. Students are paying schools, and yet they are responsible for finding their own preceptors (in some cases, or in many cases, using websites to find and pay for instructors). Shutting down these schools would be amazing, in my opinion. PTs, PAs, PharmDs, MD/DOs, do not need to find their own preceptors; you pay the tuition and it is the school's responsibility to hold their end of the bargain. That's how it should be.
I don't think it's a lack of overconfidence that leads NPs to use evidence-based resources: it's desperation and necessity. Many of our colleagues HAVE TO rely on it because they were never taught it (or it wasn't discussed in detail). I'm not sure who these psychiatrists are that you work with, but I do know that the ER docs that I work with frequently use evidence-based resources to make sound decisions in the department. I think this is obviously influenced by age, experience, preferences, etc. We've already heard countless NPs who have confessed and admitted that the education needs to be better. There is no reason that NPs should not have more classes pertaining to differential diagnosis, imaging, pharmacology, etc. These classes would undoubtedly make NPs better at what they do. I don't think having lesser quality education is a valid reason for NPs to be dependent on on these resources. All providers use these resources, the difference is that some of have a better educational foundation. That's an important distinction.
At the end of the day, our profession is shooting themselves in the foot by opening up all these new schools. History has already shown what happens to other professions who do the same thing (ex. pharmacy). At least they can lessen the blow to some degree, because they have higher requirements and there are less schools relative to nursing/NPs. There's a gluttony of NPs and the higher nursing institutions need to do something. Fast. Again...
-Why not raise the requirements slightly? Why not a 3.5 instead of a 3.0? How about requiring a GRE like every other profession? That would help to eliminate some people from the applicant pool.
-If we're going to make a gluttony of NPs, why not improve the education across the board so that they are more prepared for practice? Why not increase the clinical hours required prior to practicing? That would allow for more competent entry-level NPs.
-Why not make it a mandate (a legitimate mandate) that NP schools MUST provide clinical sites to their students? This would undoubtedly shut down schools that shouldn't be open to begin with. This, in turn, would condense the number of schools that currently exist, and keep the best schools open.
This problem is multi-factorial in nature. I've already opened a discussion topic on why I believe there should only be one certification board available to the public (i.e. AANP for NPs). Having two certification boards hurt our profession; there are no other disciplines that do this. I have never seen a profession with greater variance in skill and knowledge than our own. I’m proud of who we are but absolutely ashamed at the same time. Ignorance is bliss, but when you come from another healthcare profession and reflect on the differences, it’s easy to see all the gaps that truly exist.
Like all of my replies today this is from a phone which requires that I be somewhat succinct and limits my ability to cite sources. With that said here are some of my thoughts:
a. I have one month left for my PMHNP certification. My SO went to the same schools, works from home and earns approx. 180k per year. Your interventions might stabilize or improve our prospects, but still I’m not sure I support them.
b. My school did not find my clinical site if I were required to attend one that did I likely would not have been able to find a spot. UCF the only local school which does gives priority to medical students, and also gives priority to students who did undergraduate work there. Also, I was able to arrange hours with my preceptors something I was not able to do with my ASN or BSN classes where clinical was provided. Also, I only paid about $375,00 per credit hour.
c Whatever, the reason I believe that close adherence to evidence based guidelines usually overcomes personalized superior knowledge, but inferior application of guidelines. It is hard to beat evidence based protocols on a large scale.
d. More clinical education is always optimal. Unfortunately, most DNP programs are largely emphasizing non clinical research and systems courses. I would support integrating and taking and passing USMLE 1, 2 and 3 since that is an outcomes based measure of competence.
Specializes in DPT, DNP. Ortho, Family Practice, Psych..
32 minutes ago, FullGlass said:
We don't have an oversupply of NPs. We have a distribution problem. At least in primary care, there is a shortage of providers of all types in many parts of the country. While the number of NPs is increasing, there is still a serious shortage of primary care MDs and there is no reason to think that is going to change.
Certain MD specialties, like Ob/Gyn, are also looking at impending shortages, as the current practitioners retire and there are not enough new MDs to replace them. A lot of smaller hospitals are discontinuing L&D services. This provides opportunities for WHNPs and CNMs.
There are a lot of NP jobs out there. Small towns and cities and rural areas desperately need providers.
I am always amazed that NPs seem to think they should be able to get a job within a 5 mile radius of their current home. That is not true of any other profession. When medical students get matched, they go where they have to! Someone interested in high tech is going to move to a tech hub like Silicon Valley, Washington DC, Austin, etc. Someone who wants to be in entertainment is going to move to LA or NYC. And so on.
So, while it is difficult to get an NP job in highly desireable locations, there are plenty of other nice places to live and work.
I do agree that there need to be better standards for NP schools and would really like to see an NP residency. In addition, encourage schools to provide realistic information about where NP jobs are.
I like many of the points you made; however, I think it’s BOTH an oversupply AND a distribution problem. At the rate we’re headed, regardless of the demands that are present in certain areas, we’re going well beyond the normal healthy growth rate of a booming profession. Assuming we keep a steady growth rate with no increase in numbers each year (a big assumption to say the least), were looking at half a million NPs by 2025, at the latest. First it was 10,000 graduates. Now it’s 20,000, and according to the data, 30,000 every year. It’s a short term fix with glaring flaws down the road. These schools don’t care about the profession: they care about the $$$. Let’s be proactive and not let our profession becoming a laughingstock among our colleagues.
Specializes in DPT, DNP. Ortho, Family Practice, Psych..
19 minutes ago, myoglobin said:
Like all of my replies today this is from a phone which requires that I be somewhat succinct and limits my ability to cite sources. With that said here are some of my thoughts:
a. I have one month left for my PMHNP certification. My SO went to the same schools, works from home and earns approx. 180k per year. Your interventions might stabilize or improve our prospects, but still I’m not sure I support them.
b. My school did not find my clinical site if I were required to attend one that did I likely would not have been able to find a spot. UCF the only local school which does gives priority to medical students, and also gives priority to students who did undergraduate work there. Also, I was able to arrange hours with my preceptors something I was not able to do with my ASN or BSN classes where clinical was provided. Also, I only paid about $375,00 per credit hour.
c Whatever, the reason I believe that close adherence to evidence based guidelines usually overcomes personalized superior knowledge, but inferior application of guidelines. It is hard to beat evidence based protocols on a large scale.
d. More clinical education is always optimal. Unfortunately, most DNP programs are largely emphasizing non clinical research and systems courses. I would support integrating and taking and passing USMLE 1, 2 and 3 since that is an outcomes based measure of competence.
Congrats on almost finishing your PMHNP. I would love to do that down the road if possible.
The minute NPs are given the opportunity to attempt and pass the USMLE, PAs will come knocking for the NP exam, and they will pass it with flying colors because it is too easy of an exam. Professions don’t like intermingling, regardless of what that might bring. The PANCE is similar to USMLE 2, but outside of 1 program in the country, there are no PA to physician bridge programs. Better off just going to medical school.
You might not agree with everything I said, but I think we both agree there are glaring problems at hand. How we get from point A to point B? I’m all ears. The real question is if all the major stakeholders are listening (which they’re likely not). We know there are problems and now our profession has to come up with reasonable solutions.
Specializes in DPT, DNP. Ortho, Family Practice, Psych..
21 minutes ago, FPMHNP2019 said:
Byt most schools are accrefited by ANCE,not CCNE.
Yeah I am not familiar with ANCE's stance on this issue. All I know is that ANCE accredits practical to doctoral programs and CCNE accredits bachelors and master's degrees. It'd be great if they were both on board.
I believe that the one thing that limits medical school enrollment more than anything else is the availability of residency positions largely paid for by Medicare, and artificially “capped” by Congress. Speaking, of “for profit” schools I know several doctors who went to St. George’s in Grenada who graduated with about 280k in debt. Never heard of them you say, well you should because they place the third most residencies in the United States and part of the reason why is that unlike most medical schools they PAY, hospitals to help fund the residencies. Perhaps that’s why MD’s over at Studentdoctor.net sometimes complain that “they should have become an NP”. Also at least in Florida clinical site location IS a barrier to becoming a PMHNP. I wrote, about 160 psychiatrists and about 20 PMHNP’s that I could find all over the state and only four were taking students and only one ( the one I am graduating with) would even meet with me. If you hate the for profits now how will you feel when they start paying for clinical preference if and when your tighter standards are passed ( and don’t kid yourself the small private practices that make up most FNP and PMHNP clinical opportunities will be the first to take the money)?
Congrats on almost finishing your PMHNP. I would love to do that down the road if possible.
The minute NPs are given the opportunity to attempt and pass the USMLE, PAs will come knocking for the NP exam, and they will pass it with flying colors because it is too easy of an exam. Professions don’t like intermingling, regardless of what that might bring. The PANCE is similar to USMLE 2, but outside of 1 program in the country, there are no PA to physician bridge programs. Better off just going to medical school.
You might not agree with everything I said, but I think we both agree there are glaring problems at hand. How we get from point A to point B? I’m all ears. The real question is if all the major stakeholders are listening (which they’re likely not). We know there are problems and now our profession has to come up with reasonable solutions.
Also PA’s now have IP in at least two states ( West Virginia and Michigan?). The bill to give Florida NP’s IP also has PA’s attached ( I believe as a poison pill to defeat the measure). However, I support PA IP because I believe gaining states like Florida, Texas, and California would be a huge step for NP’s and consumers albeit with the cost of increased competition.
Specializes in Psychiatric and Mental Health NP (PMHNP).
5 hours ago, ThePTNurseGuy said:
I like many of the points you made; however, I think it’s BOTH an oversupply AND a distribution problem. At the rate we’re headed, regardless of the demands that are present in certain areas, we’re going well beyond the normal healthy growth rate of a booming profession. Assuming we keep a steady growth rate with no increase in numbers each year (a big assumption to say the least), were looking at half a million NPs by 2025, at the latest. First it was 10,000 graduates. Now it’s 20,000, and according to the data, 30,000 every year. It’s a short term fix with glaring flaws down the road. These schools don’t care about the profession: they care about the $$$. Let’s be proactive and not let our profession becoming a laughingstock among our colleagues.
I would not assume the production of NPs will continue to increase. For one thing, there is a shortage of qualified and willing faculty.
"The United States could see a shortage of up to 120,000 physicians by 2030, impacting patient care across the nation, according to new data published today by the AAMC (Association of American Medical Colleges). The report, The Complexities of Physician Supply and Demand: Projections from 2016-2030, updates and aligns with estimates conducted in 2015, 2016, and 2017, and shows a projected shortage of between 42,600 and 121,300 physicians by the end of the next decade."
In the Western U.S., there is a shortage of ALL types of providers unless one is right on the ocean, and even some smaller communities on the ocean have shortages. I'm in NE California and we need everything. We don't even have enough specialist MDs in the big cities of 1 million people plus like Fresno. We have people here driving up to 4 hours to see a specialist and even going to another state.
Personally, I think the shortage of primary care MDs will get worse, because it just doesn't pay for MDs to go into primary care, given the expense of med school and the reduced earnings of primary care. Given all the evidence supports that NPs do just fine with primary care, I think this will be taken over by NPs and PAs.
We can work to increase standards for NP education and I support mandating that NP programs find preceptors. However, we can't just keep piling on classes. That will increase the cost of education, which is already ridiculous. The real problem is clinical skills and the best way to address that is NP residency. If we increase the cost of education then being an NP does not make sense economically unless salaries increase a lot, and don't expect that to happen! Again, the evidence indicates that overall NPs provide good quality care. There really are a lot of crappy MDs out there, so don't assume they all do a fantastic job.
NP is not generally something that attracts people with no experience. Most NPs start out as RNs. So NP students tend to be a bit older and many have families. They have to work while going to NP school. We need to understand that NP education must accommodate this.
Personally, I am not interested in moving to the medical model. I am the sort of person who tries to get a 4.0, was valedictorian in high school, went to Yale for initial undergrad, management studies at UCLA, then Johns Hopkins. So a lot of my friends are doctors. A lot of these doctors have terrible people skills because the truth is they are nerds who had to focus on studies and did not develop great social skills. A lot of doctors also become doctors because their families pressure them into it. I'm half Korean and in many Asian families one is expected to become a doctor, lawyer, or engineer. Maybe a Harvard MBA is acceptable.
Nursing is a caring profession and the sort of people that are attracted to nursing have different personalities than the sort of people who are attracted to medicine. Doctors are also taught to be incredibly entitled and egotistical - I can see this and doctors have told me they are taught to be assholes in med school. In nursing, there is more emphasis on teamwork. So I am not interested in changing the fundamental nature of being an NP or the type of people who become NPs.
I'm plenty smart enough to have gone to med school or PA school, but I CHOSE to be an NP. I also made the effort to go to the best school I could.
If there is a glut of NPs, the best will get hired and the crap won't. Let's be real. If I had 10 resumes on my desk, 1 each from Hopkins, UCLA, UC Davis, Cal State LA, and the rest from crap schools, I'm going to focus on the first 4. I would consider an NP from a crap school if their experience is excellent, but otherwise no.
Given how critical health care is, I am vehemently opposed to artificially restricting the supply of practitioners. This is what MDs did and what happened? NPs and PAs came along.
I'm not afraid of some competition and those of you who are good at your jobs should not be, either.
Everyone talks about STEM, STEM, STEM. Well, pay in Silicon Valley and other tech centers keeps going up even though we have a lot of STEM people. That's because companies want the best, not crap.
There are too many lawyers. But the graduates of top schools like Harvard and so forth are still making $160K plus right out of school because they get recruited by the BEST law firms that only want the BEST candidates. That is also true of other professions like business and accounting. And people who get hired by those firms MOVE, they don't whine about not having a job right in their home town!
I think the reason schools can get away with not finding clinical placement for students is because they are not accredited by CCNE but by ANCE. I haven't seen any school's website says they are accredited by CCNE.
Specializes in Psychiatric and Mental Health NP (PMHNP).
One more thing - I don't know why students would pay a lot of money to go to a school that does not find preceptors! Would any of you gone to a nursing school for your RN if they did not find preceptors or arrange the clinical sites?
If NP students refused to go to these schools, they would fold.
Most of NP schools don't find preceptors for students. Thise very few schools that do are super expensive. Tuition ranges from 1500-1800$/credit...v.s. those that charge 400-800/credits but not place students.
FullGlass, BSN, MSN, NP
2 Articles; 1,964 Posts
We don't have an oversupply of NPs. We have a distribution problem. At least in primary care, there is a shortage of providers of all types in many parts of the country. While the number of NPs is increasing, there is still a serious shortage of primary care MDs and there is no reason to think that is going to change.
Certain MD specialties, like Ob/Gyn, are also looking at impending shortages, as the current practitioners retire and there are not enough new MDs to replace them. A lot of smaller hospitals are discontinuing L&D services. This provides opportunities for WHNPs and CNMs.
There are a lot of NP jobs out there. Small towns and cities and rural areas desperately need providers.
I am always amazed that NPs seem to think they should be able to get a job within a 5 mile radius of their current home. That is not true of any other profession. When medical students get matched, they go where they have to! Someone interested in high tech is going to move to a tech hub like Silicon Valley, Washington DC, Austin, etc. Someone who wants to be in entertainment is going to move to LA or NYC. And so on.
So, while it is difficult to get an NP job in highly desireable locations, there are plenty of other nice places to live and work.
I do agree that there need to be better standards for NP schools and would really like to see an NP residency. In addition, encourage schools to provide realistic information about where NP jobs are.